eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-09-15 8 12 486 490 10.12691/ajmcr-8-12-15 AJMCR202081215 article Yuvraj S. Chowdhury 1 Cristina A Mitre 2 Vittorio E. Rotella 3 Karan Garg 4 David K Lee 5 Pooja Belligund 5 Lu Chen 5 Paul Madaj 5 Haytham A Aboushi 6 Mohammad R. Al-Ajam 6 Samy I. McFarlane smcfarlane@downstate.edu 6 Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203 Division of Cardiovascular Disease, VA NY Harbor Healthcare System, Brooklyn Campus, New York -11209 Division of Vascular Surgery, VA NY Harbor Healthcare System, Brooklyn Campus, New York- 11209 Division of Vascular Surgery, VA NY Harbor Healthcare System, Manhattan VA Medical Center, New York- 10010 Division of Pulmonology and Critical Care, VA NY Harbor Healthcare System, Brooklyn Campus, New York- 11209 Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203 Thrombosis is one of the major underlying pathogenetic mechanisms leading to increased morbidity and mortality among COVID-19 patients. Thromboembolic events as well as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are the major causes of death in this continued pandemic. While elevated D-dimer level suggests worse thrombotic outcomes, levels at which benefits of anticoagulation outweigh the bleeding risk is yet to be determined. In this report, we present a case of a 72-year-old man with COVID-19 presented with confusion and subsequently developed acute hypoxic respiratory failure. On hospital day 7, patient developed extensive peripheral arterial thrombosis with acute rise of D-dimer from 800 to 14,899 ng/ml. He was treated with heparin drip and underwent urgent brachial, radial and ulnar embolectomy under general anesthesia. In this report, we also discuss the pathogenetic mechanisms and management of thromboembolism in COVID-19 patients, highlighting the role of early detection and aggressive therapeutic interventions that could be life and / or limb saving strategy. http://pubs.sciepub.com/ajmcr/8/12/15/ajmcr-8-12-15.pdf COVID-19 limb ischemia arterial thrombosis point-of-care ultrasound D-dimer